Chapter

Diffusion MRI in Epilepsy

Khalid Hamandi and Robert Powell

in Diffusion MRI

Published on behalf of Oxford University Press

Published in print November 2010 | ISBN: 9780195369779
Published online September 2012 | e-ISBN: 9780199965144 | DOI: http://dx.doi.org/10.1093/med/9780195369779.003.0035
Diffusion MRI in Epilepsy

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The diagnosis of epilepsy is primarily a clinical one based on the account or observation of the epileptic or ictal events. Advanced imaging in epilepsy is used to identify epileptogenic areas, primarily to best plan surgical resections. Diffusion MRI has been used to localize changes in tissue microstructure during or immediately following epileptic seizures—peri-ictal or post ictal studies—with some success. Furthermore, changes are seen interictally (between seizures). The patho-physiological changes that lead to these findings, their temporal evolution, and the sensitivity and specificity of these measures are yet to be determined. Diffusion tensor imaging (DTI) tractography in pre-surgical evaluation has been used to study language, memory, and visual pathways primarily in temporal lobe epilepsy, the most common form of drug refractory epilepsy that in selected patients responds well to surgery. Postoperative naming deficits have been found to correlate with DTI measures of language pathways, memory decline with DTI measures of memory pathways, and visual field defects with tractography of visual pathways, with particular reference to Meyers loop—an anterior extension of the pathway into the temporal lobe where it is susceptible to damage during surgical resection. These findings are motivating the application of DTI tractography in epilepsy surgery planning.

Chapter.  14750 words.  Illustrated.

Subjects: Neuroscientific Techniques

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